GPs told to refuse third party script orders in bid to cut medicines waste

GPs have been told to refuse repeat prescriptions ordered on behalf of patients by pharmacists, in a bid to cut down on medicines waste.

NHS West Lancashire CCG has tasked GPs with writing to any patients using such third-party order schemes, to explain that from next month they will have to start ordering their own repeat prescriptions.

But the CCG has also stressed that GP practices are expected to ‘support any patients or carers that have any difficulties’ with ordering their own repeat prescriptions.

The CCG is hoping that it can save £600,000 if it can successfully roll out its medicines waste publicity campaign, which has the strapline ‘being a hoarder is out of order’.

The move comes as a number of CCGs are adopting similar bans on repeat ordering, after a trial at NHS Luton CCG reportedly helped to curb its prescribing budget spend significantly last year.

Other CCGs which have moved to curb third party prescription requests include NHS North East Essex CCG, NHS Cambridgeshire and Peterborough CCG, NHS Southport and Formby CCG and NHS South Sefton CCG.

NHS North East Essex CCG, which placed a ban on third-party prescription requests last month, said it hoped the move would 'reduce wasted medicines', put patients 'in charge' and help GPs have 'a clearer picture' of medicines ordered.

It added in a statement: 'This change will help our local NHS use money more efficiently for the benefit of the residents of North East Essex.'

Commissioning leads in West Lancashire explained that its new scheme is intended to tackle medicines wastage. An estimated £300m of NHS funds is spent every year on medicines that are not used, the CCG said, equating to around £600,000 in West Lancashire alone.

In a press statement, West Lancashire CCG said that ‘GP practices across the region will no longer accept repeat prescriptions from pharmacists ordering on behalf of a patient or carer’ and that ‘patients and carers will now be required to order these prescriptions for themselves (apart from in exceptional circumstances)’.

The statement added: ‘To ease any concerns, GP practices are writing to all those affected in early October, explaining fully what is happening, when and why, and clearly explaining how they can now order their medication moving forward.

‘In addition, GP practice staff will be trained to support any patients or carers that have any difficulties.’

Asked what extra funding it was offering GP practices to help patients with repeat prescriptions in the place of pharmacies, a CCG spokesperson said: 'GP practices are not being paid anything extra, as West Lancashire CCG already funds medicines management coordinators.

'These coordinators, who have been in position for around seven years, are responsible for supporting the safety and efficiency of repeat prescribing systems.'

Patients are being encouraged to sign up to the free ‘Patient Access’ website and smartphone app available in the area, to help manage their repeat ordering.

Dr Peter Gregory, a GP at Parkgate Surgery in Ormskirk and clinical lead at West Lancashire CCG, said: ‘The NHS in West Lancashire has a responsibility to its patients to address some very important medicines safety issues. We are moving away from pharmacists ordering repeat prescriptions on behalf of patients, as there is a risk that medicines are being ordered that are no longer required.

‘With this campaign, we want to engage with patients, to give them the confidence to take control of how they take and order their medicines and to only order what they need. At its core, ultimately it is about everyone in West Lancashire working together, residents, GPs and pharmacists so that collectively we can help to tackle this issue of medicines waste.’

However, GPC clinical and prescribing lead Dr Andrew Green, a GP in East Yorkshire, cautioned that the CCG was 'wrong in thinking that a ban is the solution' to this problem and could actually cause a significant extra workload for GP practice.

He said: 'If practices have got used to large numbers of requests coming in from their local pharmacies in batches, and then all those requests are converted into individual patient contacts, it is likely that GP staff will have many more contacts to deal with, putting pressure on staff time and telephone systems.'

Sati Ubhi, chief pharmacist at NHS Cambridgeshire & Peterborough CCG, said: 'One potential contributory factor to the inappropriate provision of medicines is when medicines have been ordered on behalf of the patient by others. For the majority of our patients, it is they who are best placed to make decisions about their own health and to decide which repeat medicines they need.

'To help improve the ordering of repeat prescriptions, the CCG intend to make all practices aware of the benefits of giving patients the responsibility to manage their own medicines where they are able to do so.'

Pharmacists requesting repeat medications for patients are under no obligation to check that the patient actually needs them. This leads to over-ordering in some cases with no real mechanism in place for addressing questionable pharmacist behaviour.What is not well known is that where prescriptions are issued using "Repeat Dispensing" via the Electronic Prescribing Service, pharmacists have a contractual obligation to check that all items are actually required before dispensing them. This can be enforced through breach notices etc.Rather than make life difficult for GP's and patients by preventing pharmacists requesting meds on behalf of patients, it would be better to encourage GPs to use the repeat dispensing facility which will save all concerned a great deal of administrative work and address wastage at the same time.

There is a lot of merit in this. My experience is that pharmacies regularly order items too soon and after discussion with patients order items that the patient hasn't actually asked for. I'm often met by the comment the 'the chemist keeps sending me them'. I have had first hand experience of this with my parents' prescriptions.Pharmacies requesting prescriptions actually causes me more work!

Personally, I am delighted that GPs are prepared, nay, enthusiastic about taking this particular workload from Pharmacists. Benefits to Pharmacists - no Monday morning telephone calls for "Urgently required medication" when the patient could (should?) have ordered them 5 days previously, no more patient accusations of "You've sent me the wrong thing" when in actuality, the incorrect item was issued by the practice; Thanks, GPs, this will make our lives much easier. Benefits to patients? Oh, I didn't think anyone was considering the patients. BTW Given that many practices no longer take prescription requests by phone (email or written only - good idea - creates audit trail) how will this work for the non-it savvy housebound?

The problem is very real. The typical example we have encountered in here is particularly when elderly patients were admitted to hospital . Neither GP nor the pharmacy was aware of this. Then when the patients were discharged home days later , bags of repeat prescriptions were on the doorsteps . Many of the repeat prescriptions were already stopped or changed during the admission .

I agree the systems in place are not ideal but this is a knee-jerk reaction to try to solve a bigger problem - medicine wastage is created by patients over-ordering and by GPs prescribing in quantities which are too large, such that when a medicine is changed, you cannot help but have lots of waste. Might I suggest that the LMCs & LPCs sit down and come up with local schemes, without the apportioning of blame, to resolve this

related - but not directly - generic prescribing. We keep being told by the CCG that prescribing brand X or Y is cheaper than Z. Unfortunately a few months down the line it is Z that's cheaper. Does someone need to look at the drug Tariff rules that make brands cheaper than generics?